Clinical Practice & Philosophy

Practice

My clinical interests have developed over 40 years of practice. I am well-known for my work with children and teenagers who have both engaged in and been affected by risk-taking. This area includes disordered eating, high-risk sexual activity, including sexual abuse and online sexual activities, as well as anxiety and depression.

Although I frequently work with children and adolescents, I also enjoy working with adults of all ages on issues ranging from desire for creativity, to development of relationships, or even struggles with occupation or retirement.

Philosophy

I view psychiatric work as a partnership between others and myself. This partnership can occur with a child, adolescent or adult and sometimes takes place with a family. A key aspect of this relationship is the initial reason that prompts an individual or family to seek treatment. Equally important is the meaning that treatment has for them. At the beginning, many feel anxious. In my clinical work, I strive to help my clients feel comfortable. My assessment includes a careful consideration of fluctuating mental states and key relationships in a person’s life, as well as family and cultural patterns. I also strive to develop an understanding of an individual’s biology by asking and encouraging questions about connections between mind and body.

I join with my clients to help them discover meaning and purpose in their struggles, aiming to be pragmatic and closely attentive to behavior. How do our actions reflect our psychology and conversely how is our psychology affected by our actions? Lastly, I believe all therapy occurs in a developmental frame whether we are children, adolescents or adults—events in childhood and adolescence have a huge impact on later lives, but developmental changes occur even in our last decades.

Underlying my therapeutic perspectives are my strong beliefs that people can change and, even more specifically, are constantly changing. Understanding this is key. I believe that therapeutic partnerships aid us in this process. Psychotherapy with children and adolescents is particularly complex and benefits from an open non-dogmatic approach. I also use this approach with adults. Embedded in an overall developmental framework, I view the following perspectives essential to consider in psychotherapy with either children, adolescents, or adults:

Relational-Dynamic

This perspective combines traditional dynamic principles of psychotherapy, including consideration of therapeutic alliance, attachment, conflict, and negotiation of boundaries. This therapeutic perspective is currently used by many who work with children and adolescents. It is both complex and powerful in its abilities to address a number of the problems that children and adolescents are struggling with. For example, struggles an adolescent girl is having with a parent may play out in her individual therapy.

Family & CulturalPerspectives

One of the unfortunate schisms in psychotherapy has been the separation of individual psychotherapy from family therapy. This divide is particularly unfortunate in working with children and adolescents. I believe that it is essential to address key family issues in psychotherapeutic work not only with children and adolescents but with adults. Integrating family perspectives into my work with children and adolescents may include seeing the referred child or adolescent with their entire family, seeing the child or adolescent individually or meeting with family members separately.

Cognitive Behavioral & Symptom-based Perspectives

Approximately a third of all psychotherapists primarily utilize a cognitive-behavioral therapeutic perspective. This perspective reminds us of the importance of looking at an individual’s behavior and setting discrete treatment goals. It also underscores the importance of thoughts, particularly false beliefs in maintaining problems as it offers strategies to address them, and this perspective integrates well with others.

Perspectives of Meaning

This perspective emphasizes discovering meaning in life. I believe even a child or adolescent may find meaning in personal or cultural myth and primarily use their senses rather than cognitive processes to understand their world. The importance of meaning has often been ignored in psychotherapeutic work, but it is vital to address. For example, children and adolescents always wonder why they are being taken to therapy. It is important to begin this conversation at home, even before a first visit, but it is also important to let the child know it will be an on-going conversation and that their input is important. As a second example, those who have suffered trauma or serious medical or psychiatric illnesses ask why these events have happened to them. Many incorrectly blame themselves. This too has to be talked about directly.

Biological Perspectives

Centuries ago, Descartes introduced the concept of mind body dualism in the Western world, separating mental phenomena from the psychical body. One of the consequences of his work and the work of those who followed him was to divide mind from body, failing to understand the importance of considering these parts as a whole. During past centuries scientific knowledge has contributed much to our understanding of the body and the mind, but it has too often participated in this false division. Recently, biological perspectives have become more integrative and add to our psychotherapeutic knowledge. As an example, psychiatric medications and therapy can be vital partners in treatment. Here again, open discussion is key.

Current Writing

I have always found value in writing. For me, it offers a powerful tool for sharing secrets of my chosen field of psychology, and even more importantly, of life itself.

Advocacy

I have a strong commitment to advocacy, particularly in understanding and addressing the needs of abused children within the state of California and nationwide.

Teaching

I enjoy working with others who have strong passions for psychiatry and psychotherapy. I have been fortunate to have had many good teachers.

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